Wednesday, July 10, 2019

Appeals court sounds likely to uphold ruling against ACA; Democrat says the law 'is the future of rural health care'

"A panel of federal appeals court judges on Tuesday sounded likely to uphold a lower-court ruling that a central provision of the Affordable Care Act — the requirement that most people have health insurance — is unconstitutional," reports Abby Goodnough of The New York Times. "But it was harder to discern how the court might come down on a much bigger question: whether the rest of the sprawling health law must fall if the insurance mandate does."

The law "is the future of rural health care," said Andy Beshear, the Democratic nominee for governor of Kentucky and one of 21 Democratic attorneys general who intervened in the Texas lawsuit that led to a federal district court ruling that the entire 2010 law violates the Constitution.

Without the law and its expansion of Medicaid to people earning up to 138 percent of the federal poverty level, many more rural hospitals would be in trouble, Beshear told Kentucky Health News, because they would not only get less revenue but have to write off the cost of care for people who wouldn't be able to afford health insurance.

Beshear is the son of former Gov. Steve Beshear, who expanded Medicaid under the reform law. His opponent is Republican Gov. Matt Bevin, who initially campaigned on repealing the expansion but now wants to require work or other "community engagement" from "able-bodied" people covered by the expansion. Most of them work, but Bevin has argued that the benefits keep some from working.

In Tuesday's oral arguments, "Two appellate judges appointed by Republican presidents peppered lawyers with blunt questions while the third judge, appointed by President Jimmy Carter, remained silent," Goodnough reports. "The two Republican appointees, Jennifer Walker Elrod, appointed by President George W. Bush in 2007, and Kurt Engelhardt, appointed by President Trump in 2018, seemed particularly skeptical of the Democratic defendants’ argument that Congress had fully intended to keep the rest of the law when it eliminated the penalty for going without insurance as part of its 2017 tax overhaul."

"Despite such pointed questioning, the hearing did not clearly foreshadow how the panel will rule," reports Amy Goldstein of The Washington Post. The newspaper also reports that Senate Majority Leader Mitch McConnell refused to say whether he supports the lawsuit, but focused on coverage of pre-existing conditions, which has also been the focus of Democrats. “I think the important thing for the public to know is there is nobody in the Senate not in favor of covering pre-existing conditions,” the Republican leader told reporters at the Capitol. “And if it were, under any of these scenarios, to go away, we would act quickly on a bipartisan basis to restore it.”

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